Noise exposure in both residential and occupational settings produces a range of auditory and nonauditory health problems. Efforts of the relevant authorities to reduce these effects may be supplemented by the adoption of various self-protective behaviours by individuals. Unfortunately campaigns designed to encourage such self-protective behaviours are likely to meet with limited success. The present paper considers the shortcomings of such campaigns and offers prescriptions for improving them. Campaigns based on these prescriptions and on thorough research of the factors involved in health promotion generally, as well as those particular to each case, should significantly advance efforts toward individuals protecting themselves against the ill effects of noise exposure.

Noise exposure in both residential and occupational settings produces a range of auditory and nonauditory health problems. Efforts of the relevant authorities to reduce these effects may be supplemented by the adoption of various self-protective behaviours by individuals. Unfortunately campaigns designed to encourage such self-protective behaviours are likely to meet with limited success. The present paper considers the shortcomings of such campaigns and offers prescriptions for improving them. Campaigns based on these prescriptions and on thorough research of the factors involved in health promotion generally, as well as those particular to each case, should significantly advance efforts toward individuals protecting themselves against the ill effects of noise exposure.

Noise has been shown to produce various ill effects in a range of settings. For example, occupational studies have demonstrated that noise exposure contributes to hearing loss (Morata, 1999; Ward, 1993), and may have a detrimental impact on cardiovascular health (Talbott et al., 1996). Noise has also been found to impair performance both in occupational (Smith, 1989) and educational settings (Haines, Stansfeld, Job, and Berglund, 1998; Hygge, Evans, and Bulinger, 1998). Community surveys demonstrate negative reactions (Fields, 1994; Hatfield and Job, 1998; Job, 1988a) and sleep disturbance (Griefahn, 1992; Griefahn et al., 1998; Ohrstrom, Bjorkman, and Rylander, 1990; Pearsons, Barber, Tabachnick, and Fidell, 1995) resulting from noise exposure. Noise associated with entertainment (e.g. loud music) has been found to have deleterious effects on hearing (Axelsson and Prasher, 1999). The role of noise exposure in several further health effects is less clear. For example, the effects of aircraft noise on children's blood pressure are uncertain (Cohen, Evans, Krantz, and Stokols, 1980; Morrell, Taylor, Carter, Job and Peploe, 1998). Although suggestive of a greater prevalence of psychiatric illness amongst residents of high noise areas, the evidence is inconclusive (Abey­Wickrama, A'Brook, Gattoni, and Herridge, 1969; Jenkins, Tarnopolsky and Hand, 1981; Kryter, 1990). Nonetheless, theoretical and empirical considerations suggest a causal role of noise in these health problems (see Job, 1996).

These effects of noise are made more concerning by pervasive increases in noise exposure (Berglund and Lindvall, 1995). However, much can be done at an individual level to ameliorate these impacts. For example, behaviours that reduce exposure can reduce noise effects. In occupational settings hearing protection devices are clearly beneficial for hearing conservation (Berg, 1998; Franks, 1998) and in residential settings exposure can be reduced by installing noise insulation, glazing and/or closing windows or simply using rooms in a manner which minimises exposure (for example, by using rooms with the lowest noise levels as those most frequently occupied or for sleeping). Further, several effects may be reduced without a reduction in overall exposure. For example, individuals may have less negative reactions to noise if they perform activities requiring concentration or speech communication during relatively quiet periods. Using the quietest room in the house as a bedroom may reduce sleep loss.

It might be argued that the authority responsible for the noise sources, rather than the individuals exposed to it, should see to minimising the deleterious impacts of that noise (see Douglas, 1992; Douglas and Widavsky, 1982; van Gunsteren, 1999). Ideally these authorities would do their utmost to minimise noise emission, thereby reducing the effects. However even their best feasible efforts might valuably be supplemented by individuals' own actions. Further, the efforts of authorities responsible for the noise sources may be limited by competing motivators (such as profit), and effective promotion of individual health behaviour can be of substantial benefit to the individuals. Nonetheless, promotion of health behaviour at the individual level should not be regarded as a substitute for lobbying authorities to minimise detrimental noise impacts.

Many organisations and campaigns aim to persuade individuals to behave in a manner which minimises the negative effects of noise (see Mangan, 1999; Newton, 1999). The success of such campaigns in reducing the health effects of noise has been limited. Several reasons for this outcome are considered below. We then offer prescriptions for improving messages and campaigns to promote self-protective behaviour. These are based on extensive research and evaluation of such campaigns addressing other public health issues (e.g. road safety, smoking, skin cancer, sexually transmitted diseases).

Campaigns rarely go beyond making the point that noise is somehow harmful. However, the simple information provision approach has been shown to be inadequate in relation to various public health issues (e.g. road safety, smoking).

Most campaigns designed to promote healthy behaviours in relation to noise have addressed only the issue of hearing loss. Whilst hearing loss is a major area of concern, this focus, which ignores the numerous other detrimental effects of noise, is unwarranted. As outlined earlier in this paper, noise has many nonauditory health consequences from which people can protect themselves.

Ineffective campaigns have serious consequences besides the waste of time, money and effort. Specifically, they reduce the likely efficacy of subsequent campaigns, perhaps by immunising their audience against safety messages (Janis, Lumsdaine and Gladstone, 1951; McGuire, 1962). Several considerations should improve the efficacy of campaigns designed to promote noise-related health behaviours.

First, the causes of undesired behaviours should be researched. These causes are often naively assumed without adequate justification, and campaigns based on inaccurate assumed causal mechanisms run the risk of worsening the situation. When the causes of an undesired behaviour have been established, campaigns may be designed to target them effectively.

Second, motivation to engage in desirable behaviours needs to be established (Job, 1987). Often people are aware that noise can be harmful and know about protective behaviours, and so providing information is superfluous. Individuals' failure to engage in protective behaviours is often not due to lack of knowledge but due to lack of motivation. People are generally motivated to preserve their health, however their motivation to engage in protective behaviours is inhibited by a failure to acknowledge personal vulnerability. People tend to believe that they are less likely than their peers to experience negative events (e.g. having a heart attack, being injured in a car accident) and more likely to experience positive events (e.g. having a gifted child, winning the lottery) (Kirscht, Haefner, Kegeles, & Rosenstock, 1966; Weinstein, 1980; Kulik & Mahler, 1987; Lee & Job, 1995; for review see Weinstein, 1989). It has been hypothesised that this phenomenon, referred to as optimism bias, inhibits precaution taking (Weinstein, 1988). Further, evidence suggests that estimates of risk relative to one's peers are at least as important as estimates of one's absolute personal risk in determining behaviour (Klein, 1997). Hatfield and Job (1998) demonstrated optimism bias regarding the health effects of noise. That is, people believe that they are less likely than their peers are to suffer the negative effects of noise. This is likely to have implications for adoption of noise­relevant precautions. An individual's belief that s/he is less likely than others to suffer the ill effects of noise may result in messages regarding the risks associated with noise exposure being subtly interpreted as messages for others, rather than the individual him/herself. Unfortunately, most individuals may view information or other messages in this way unless the problem is redressed. As long as people do not believe that exposure to noise puts them personally at risk, they are unlikely to engage in behaviours which protect them against the health effects of noise. Thus, campaigns designed to promote adoption of such protective behaviours should seek to make the messages salient and personally relevant to the targeted individuals.

Third, barriers to desirable behaviours need to be removed or minimised. For example, individuals may not be convinced that the behaviour is effective and so not see the point in engaging in it. Further there may be significant costs associated with the behaviour, in terms of money, time, social acceptability or convenience. Thus, campaigns may need to promote the perceived efficacy of the desired behaviours or reduce the perceived costs associated with them in order to be effective. For example, campaigns against teenage smoking based on teaching the social skills which allow teenagers to say no to cigarettes and to withstand the social pressures around them without feeling alienated from their peer group have been effective (Evans et al., 1981). Similar social stigma may exist around the use of hearing protection devices in some workplaces. This possibility should be evaluated and, if necessary, addressed.

Finally, the use of fear in health promotion must be considered carefully. Positive reinforcement approaches tend to be more effective and less likely to backfire than fear campaigns (Job, 1988; McGuire, 1962). Thus, if the desired behaviour can be imbued with a positive value, it is more likely to be adopted than one that is valued only in virtue of reducing fear or anxiety. However, in some cases this positive valuation is difficult to achieve and campaigns based on fear may be appropriate. Nonetheless, campaigns based on fear must be employed carefully in order to be effective rather than counterproductive.

Fear campaigns may be more effective if they achieve reinforcement of the desired behaviour with a reduction in the level of fear, by satisfying the following five requirements (see Job, 1988b) The health message should produce the onset of fear before presenting the desired behaviour, so that fear termination can function as a reinforcer for the desired behaviour. A reinforcer increases the strength or likelihood of a response. A reinforcer may be a desired event (e.g. food, fun etc) or the termination of an undesirable event (e.g. pain, fear etc). Thus, the termination of worry about hearing loss, or another health problem, may be a reinforcer. Thus, the message 'You should install noise installation or your health will be harmed' would not be as effective as 'Your health will be harmed, unless you install noise insulation'.

The fear-inducing event should appear to be likely. For example, suggesting that noise damages hearing is more credible that suggesting noise causes deafness. It is more difficult for individuals to deny personal vulnerability to events that are likely than to events that are unlikely.

The health message should offer explicitly a specific, precise desired behaviour. If individuals are not presented with a clear behaviour to combat the fear-inducing event, fear termination cannot function as a reinforcer for the desired behaviour. Further, individuals may deny personal vulnerability in order to reduce the fear.

The level of fear should not be excessive, and should be amenable to substantial reduction by the behaviour presented. If this is not the case, denial is likely to occur. For example, the message 'Exposure to noise will cause you to have a heart attack, unless you glaze your windows' is not as good a message as 'Exposure to noise is likely to increase your blood pressure, unless you glaze your windows'.

The behaviour should be perceived as effective in order to allow fear termination. Only if the behaviour is perceived to be a credible solution to the fear-inducing event will fear termination occur, in turn reinforcing the behaviour. Thus, as identified earlier, campaigns can benefit from identifying the effectiveness of the suggested desired behaviour.

In summary, there are many ways in which individuals can protect themselves from various detrimental effects of noise exposure. Campaigns promoting self-protective behaviour can be improved by increasing perceived personal vulnerability to noise-induced health effects, promoting the perceived efficacy of desired behaviours and minimising the perceived and actual costs of these behaviours. Such campaigns should employ fear carefully, and should address both auditory and non-auditory noise effects. Whilst, effective promotion of self-protective behaviour at the individual level is of considerable value, it should not replace broader efforts to reduce the harmful effects of noise.[40]